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Exercise and the Heart: Benefits, Risks and Adverse Effects of Exercise Training
Exercise has multiple health benefits and reduces cardiovascular morbidity and mortality. Regular exercise decreases the burden of cardiovascular risk factors and improves prognosis in several cardiac conditions. Despite these premises, sudden cardiac death (SCD) during sports may occur in apparently healthy athletes who perform at the highest levels. Accurate identification and prompt treatment of individuals at risk may reduce the burden of SCD. A possible cardiotoxic effect of intense exercise has been recently postulated, however this is still matter of controversy as causal relationships are often difficult to establish taking into account multiple confounders. Exercise is safe for the majority, even with cardiovascular disease. In this review, we focus on exercise and sports, discussing their benefits and risks and exercise recommendations for healthy individuals and those with cardiovascular disease
Multi-lead cephalic venous access and long-term performance of high-voltage leads.
BACKGROUND: Cardiac resynchronization therapy-defibrillator (CRT-D) implantation via the cephalic vein is feasible and safe. Recent evidence has suggested a higher implantable cardioverter-defibrillator (ICD) lead failure in multi-lead defibrillator therapy via the cephalic route. We evaluated the relationship between CRT-D implantation via the cephalic and ICD lead failure. METHODS: Data was collected from three CRT-D implanting centers between October 2008 and September 2017. In total 633 patients were included. Patient and lead characteristics with ICD lead failure were recorded. Comparison of "cephalic" (ICD lead via cephalic) versus "non-cephalic" (ICD lead via non-cephalic route) cohorts was performed. Kaplan-Meier survival and a Cox-regression analysis were applied to assess variables associated with lead failure. RESULTS: The cephalic and non-cephalic cohorts were equally male (81.9% vs. 78%; pβ=β.26), similar in age (69.7βΒ±β11.5 vs. 68.7βΒ±β11.9; pβ=β.33) and body mass index (BMI) (27.7βΒ±β5.1 vs. 27.1βΒ±β5.7; pβ=β.33). Most ICD leads were implanted via the cephalic vein (73.5%) and patients had a mean of 2.9βΒ±β0.28 leads implanted via this route. The rate of ICD lead failure was low and statistically similar between both groups (0.36%/year vs. 0.13%/year; pβ=β.12). Female gender was more common in the lead failure cohort than non-failure (55.6% vs. 17.9%, respectively; pβ=β.004) as was hypertension (88.9% vs. 54.2%, respectively, pβ=β.038). On multivariate Cox-regression, female sex (pβ=β.008; HR, 7.12 [1.7-30.2]), and BMI (pβ=β.047; HR, 1.12 [1.001-1.24]) were significantly associated with ICD lead failure. CONCLUSION: CRT-D implantation via the cephalic route is not significantly associated with premature ICD lead failure. Female gender and BMI are predictors of lead failure